Transforming lives throughpositive parenting

Matthew R Sanders, Ph.D. Parenting and Family Support Centre

The University of Queensland

HFCC, Feb 2018Santa Rosa, CA, US

Can we really transform

children's lives in a

meaningful way?

Approach must address

determinants of parenting

Activation of community-

wide processes to support positive

parenting

Population level change in

parenting is required

Quality of parenting has a pervasive impact on children's development

Parent-child relationship

and parenting practices

Healthy brain development

Moral development

Language, communication, literacy

Executive functions and self regulation

Academic attainment

Social skills and peerrelationships

Conduct problems/antisocialbehavior

Obesity

Chronic health problems

Pain management

Anxiety and stress

Sedentary behavior andphysical activity

Screen time/Online behaviorAttentional problems

We must target modifiabledeterminants of parenting

Biologicalgenetic influences

Personality, sociability, maternal health

Interactionalprocesses

Reciprocity, attachment

Characteristics of children

Temperament, preterm, disability, exposure to trauma

Parental behavior, affect, cognition

Cognitive factors

Expectations, beliefs,attributions, knowledge Relationship

factorsSupport, conflict, violence

Economic factors

Financial resources, poverty, unemployment

Cultural factorsReligion, cultural values, mores, traditions, taboos

Parental mentalhealth

Depression, anxiety,substance abuse

Self regulationExec functions

Self managementAttention, impulse control

Adverse life experiencesACE’s, trauma

Enhancing Impact

Key themes

Enhance relationship capability

Promote self regulation

Ensure cultural relevance

A multi-level systemBlends universal and targeted interventions

Level 5Individual, Group

Level 4Individual, group, self help, online

Level 3Individual, group, online

Level 2Individual, group

Level 1Universal level

Intensive family intervention………................

Broad focused parenting support………...

Narrow focus parenting support………….

Brief parenting advice……………………………

Communication strategy…………….

Breadth of reachIntensity ofintervention

Low intensity or

“light touch”

Mediumand highintensity

Very low intensity

Principle of “Proportionate universalism”

(Marmot, 2010)ensures level of

support appropriate to

need

Some core values underpinning Triple P

• Be inclusive• Create equal opportunities• Empower parents• Raise children as a shared responsibility• Harness broader community influences to

support good parenting• Recognize that children are our greatest

resourceAdapted from: Sanders, M.R & Mazzucchelli, T.G. (2018). The power of positive parenting: Transforming the lives of children, parents and communities using the Triple P System. New York, NY:Oxford University Press

Positive trial findings with many different types of children/ target problems

Conductproblems

Bedtimeproblems

Mealtimeproblems

Habitdisorders

Anxietydisorders

Recurrentabdominal

pain

ADHD

Severefeedingproblems

Gifted andtalentedchildren

Conductproblem

ad olescents

Children innatural

disasters

Peervictimisation

Children withchronicillnesses

Obesechildren

Children atrisk of abuse

Children withASD or IDD

Different types of children/

problem behavior

..in diverse cultural contexts

The continued commitment to evidence

Program gets a name

International dissemination

begins

First population trial published

Total papers = 884

Evaluation studies =298

Conceptual papers =585

Authors = 1271

Institutions = 394

Countries = 330

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• Number of RCTs=151• # of service based evaluations=66

(22%)• Number and % of studies with null

findings 13 (4%)• Number of studies without

developer involvement=150 (50%)

Parent Wellbeing

Implementation of Triple P System

Creates positive changes in

parenting and family relationships

Activates community

processes that support parenting

Leads to Better Child

Outcomes

Harsh, Coercive Parenting

Parental Self

Efficacy

Positive Parenting

CollectiveEfficacy

Social Supportfor Parenting

Social Cohesion and Trust

Community Social Capital

Parental Teamwork

Family Conflict

Better Child Outcomes

• Fewer cases of child abuse and neglect• Lower rates of child abuse related

hospitalizations and injuries• Fewer out of home placements

• Lower rates of serious behavioral and emotional problems

• Reduced risk for antisocial behavior, substance abuse, serious mental health problems

Reduced child

maltreatment

Better mentalhealth

Improved school

outcomes

• Improved academic attainments (literacy-numeracy)

• Fewer conduct problems at school• Lower rates of truancy

Enhancing Impact

Key themesEnhance relationship

capability

Promote self regulation

Ensure cultural relevance

Self regulation and parenting

The capacity to self-regulate is a fundamental process underpinning the

maintenance of positive, nurturing, non-abusive parenting practices that promote

social and emotional well being of children

Parental self regulation in action

• Has a clear sense of values, behaviors and skills

• Has realistic expectations of child,self and others

• Self-monitors own behaviour automatically

• When valued outcomes are threatened brings behavior under personal voluntary control

• Tunes in to own actions, knowledge and skills to developplan

• Carries out the plan• Has positive expectations• Is reflective, without too being self

critical• Reflections are constructive and

increase self efficacy• Uses self-regulation skills as required• Mostly enjoys the process

Sanders, M. R., & Mazzucchelli, T. G. (Eds.). (2017). The Power of Positive Parenting: Transforming the Lives of Children, Parents, and Communities Using the Triple P System. Oxford University Press.

• Teaches self management skills• Personal goal setting, self monitoring, checking change

goals against values• Modeling, prompting and fading, reinforcement

• Builds in strategies to promote flexibility, generalization• Train “sufficient” exemplars• Train “loosely”• Reinforce generalization

• Teaches emotion management• “Causes”• Avoid escalation traps• Stress management

• Addresses unhelpful cognitions• attributional bias

HowTriple P

can promote self- regulation

Keythemes Enhance relationships

Promote self regulation

Ensure cultural relevance

Transforming the lives of children and parents

By enhancing relationship

skills

Parent/sSanders & Mazzucchelli (2018)

GrandparentsKirby & Sanders (2014)

SiblingsPickering & Sanders (in press)

PeersHealy & Sanders (2014)

Teachers/ECE/Carers

Parents

Children

Poor relationships

adversely affects

children’s well being

Parent/s

Grand parents and kinship carers

Children’s teachers/carers/

coaches

Lack of modeling and reinforcement of prosocial

behavior

Poor social skillsPoor conflict management Poor emotion regulation

Increased risk of

behaviour and

emotional problemsPeers/Siblings

Enhancing children’s relationshipsto reduce bullying

Parenting influences children’s peer

relationships, social skills, emotional

regulation and sibling relationships.

Builds on evidence showing parenting influences children’speer relationships

• Children’s social competence (McDowell and

Parke , 2009), is a strong predictor of victimization (Cook, Williams, Guerra, Kim & Sadek, 2010)

• Children’s ability to regulate emotionsis a risk factor for being bullied (Card, Isaacs & Hodges, 2007).

• The emotional impact of bullying on children (Bowes, Maughan, Caspi, Moffitt & Arseneault, 2010).

• Children’s peer acceptance (McDowell and Parke ,

2009), is strongly associated with victimization (Rejntjes, Kamhuis, Prinzie &Telch, 2010).

• Children’s sibling relationships and bullyingbetween siblings predicts increases in peer victimization two yearslater (Stauffacher & DeHart, 2006).

Facilitative parentingrefers to parenting

practices that supports children’s peer interaction and

relationship skills

Facilitative parenting involves

• Being warm and responsive• Enabling appropriate independence• Supporting children’s friendships• Coaching and enabling children’s social problem solving• Resolving conflicts effectively in the family• Maintaining good communication with child’s school

Resilience Triple P

StructureAn eight (8) session group program for families concerned about the bullying of their child

Aims• To reduce bullying• Improve peer

relationships• To reduce the

adverse emotional impacts of bullying

Facilitative parentingtraining for parents

(4, 2hr sessions with parents)

Social emotional skillstraining for children

(4, 2hr sessions with children andparents)

Specific child and parent skills targeted

Child skills

• Play skills• Everyday body language• Responding calmly and

assertively to provocation (verbal and non-verbal skills)• Resolving conflicts

• Interpreting peer situations• Self-regulatory skills

Parent skills

• Being warm and responsive• Enabling appropriate independence• Supporting children’s friendships• Coaching and enabling children’s

problem solving• Resolving conflicts effectively in the

family• Maintaining good communication

with the school

Video clips used to introduce topic/skill : Responding to peer behavior

• 111 families of children reported (by parents) to be chronically bullied including approximately 2/3’s “passive” and 1/3 “provocative victims”

• Families randomized to immediate startResilience Triple P or Active Control

• Assessment points at 0, 3 and 9 months• Progress monitored by multiple informants

(child, parent, teacher, actor role-plays, observationalcoding)

• Used Intention to Treat (ITT)

RCT of Resilience Triple P

Overt Bullying of Child:Teacher report

1.61.41.2

10.80.60.40.2

0

1.82

Resilience TPTreatment effect sized =.57 (med)

Active control

0 months 3 months

9 months

Bullying of child Teacher report

“I like school”: Child report

d=.65 (med)

4.54

3.53

2.52

1.51

0.50

Resilience TP

Active Control

0 months3 months9 months

“This program worked so rapidly that I alreadyhave my first ex-girlfriend.”

Joel 9 yrs

Summary

At 9 month follow up compared to controls, RTP children experienced– Less bullying (child, parent, teacher report)– Less depression– Less aggression– Improved social skills– Greater liking of school– Greater liking of same and opposite sex peers– Less distress from peer behavior

• High levels of program satisfaction from both parents and children

Parents relationships

matter

Partners, Ex partners

Own parents, extended family

Children’s teachers/carers/

coaches

Lack of support Criticism

Disapproval Feeling judged

Violence

High stress Conflict

Dysregulated emotions

Avoidance

Inconsistent or coercive parenting practices

Peers, other parents, neighbors

Social connections matterand provide a context for parenting support

Parenting practices

Grandparents

Other parents

Religiousorganizations

Friends

Neighbors

Carers

Coaches

TeachersPartner

Emergingthemes

Enhancing relationships

Promoting self regulation

Cultural adaptation

Addressing cultural diversity

through partnerships

Collaborative Partnership Adaptation Model (CPAM)

Turner, Sanders, Keown & Shepherd (2018)

Collaborative Partnership Adaptation ProcessTurner, Sanders, Keown & Shepherd (in press). Collaborative parentship adaptation model. In Sanders, M.R, & Mazzucchelli, T.G (Eds.). The

Power of Positive Parenting: Transforming the lives of children, parents and communities using the Triple P System. New York, Oxford University Press.

NgatiHineHealthTrust

CPAM process

Establishment of collaboration

partnerships with Maori

organization

Review existing evidence on

program effectiveness

Review evidence on

cultural adaptation

Assess cultural

acceptability of existing program

Adapt program

Scale up program

Evaluateadaptedprogram

Triple P Discussion Groupsas brief low intensity intervention

• 2-week, 2 hr per week, level 3 Triple P Discussion group intervention (Being a positive parent, Dealing with disobedience)

• Triple P principles linked to the tikanga (Maori way of doing things) of the local iwi (tribe)

• Culturally appropriate methods used to welcome participants into the group through karakia (prayer), mihi whakatau (welcome) and whakawhānaungatanga (getting to know each other).

• Culturally appropriate examples to illustrate within sessionexercises.

Effects of Triple P Discussion Groupsfor Maori Parents

Other outcomes at follow up

Outcome measure Cohen dEffect size at Follow up

Conduct Problems ECBI Intensity d=.53ECBI Problem d=.73

SDQ Emotional symptoms d=.88Peer problems d=.82

Dysfunctional parenting (Parenting Scale)

Laxness d= .4Over reactivity d= .46

Self efficacy PTC Setting d=.33 PTC Behavior d=.32

Parenting conflict PPC Extent d=.54PPC Problem d=.72

Relationship Quality RQI d=.54

Summary

• Collaborative partnering process was successful in producing brief, culturally acceptable parenting intervention

• Program seems a valuable “light touch” intervention that could be used as universal early prevention parenting program

• Findings presented in Wellington to Minister Peeni Henari

Emergingthemes

Promote self regulation

Enhance relationships

Ensure cultural relevance

Parenting and theenvironment

Nature and significance

• Over 3 billion people rely on protein from marine ecosystems to survive

• Marine resources contribute hundreds of billions of dollars to the economy every year

• Our oceans sustain the livelihoods of 10-12% of the human population

The Problem

• Approximately 90% of marine ecosystems are being overfished or fished at capacity

• 8 million tonnes of plastic waste is dumped into the ocean each year• Plastic waste poisons ecosystems

• Without the support of marine ecosystems, coastal communities struggle to maintain their way of life

Coral reefs are being degraded by

• Fishing using cyanide anddynamite (“bombing” fishing)

• Pollution from sewage andagriculture

• Massive outbreaks of predatory starfish, invasive species

• Sedimentation from poorland use practices

Project Location

Selayar is located in Sulawesi, Indonesia. 80% of pop reliant on marine

resources

Sample program materials

A guide for promoting family level change to

foster ecologically sustainable behaviors in families in coastal

households

100 bags of plastic collected and donated to local village. Plastic was(A) sorted and properly disposed of (B) sold at garbage banks.

Bontolebang Village nominated for cleanest, healthiest village in Indonesia.

Summary of findings

Following intervention participants• Increased collection and disposal of plastic

waste• Use of larger vs smaller water bottles• More likely to check source of fish• Collected 100 bags of plastic and with

recycled or used them to make ornaments• Cleaned up their village• Greater problem solving skills• Life satisfaction• Action had more impact• Greater empowerment and personal agency

Future of evidence-based parenting support

• Need for ongoing innovation• Keep improving positive parenting techniques (e.g.

Salmon et al, 2013)• Responding to individual differences in parental

capacity to self-regulate• Mechanisms of change• Preparing practitioners to deal with more difficult

cases/non responders• More research on online professional training

KEY QUESTION REVISITED

Can we really transform children’s lives in a

meaningful way?

Parenting must become a

policy priority and be funded

accordingly

Activate community-

wide processes that support

positive parenting

Happier, healthier, better adjusted child,

parents and communities

WE CANDO THIS

Disclosure statement

• The Triple P-Positive Parenting Program is owned by the University of Queensland. UQ licensed Triple P International Pty Ltd to disseminate the program worldwide

• Royalties are distributed to the Faculty of Health andBehavioural Sciences, School of Psychology, PFSCand contributory authors

• Professor Sanders is the founder, lead author and aconsultant to Triple P International

Thank you for your attentionfor more information

pfsc.uq.edu.au (R & D)triplep.net (training, dissemination, implementation support)

tprn.net (research network)